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Ask the Mental Health Expert Archives 2001-2004

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Anger Management

Q. Currently I am taking Zoloft for anger management. I do not feel that it is working all of the time. Would you please send me a list of alternative medications commonly used for anger management, that I could research before switching. What else is recommended?

A. Anger is complex phenomenon, with many possible causes, both physical and psychological. Thus, a medication that might be helpful for one type of patient may not be appropriate at all for another. For example, some individuals with epilepsy may have periods of anger or dyscontrol that will respond to anticonvulsant medications-but these might not be helpful for someone who becomes angry when somebody cuts him off on the highway.

Therefore, the first step in managing anger is to understand its origins. This may involve a medical and/or a psychological evaluation. Once that is done, the choice of medication may become clearer. Since you are already receiving medication from a physician, I assume that you have had such an evaluation--but I still can't say which medications would be helpful for you.

Among the agents most commonly used in managing anger and aggression are the following: serontonergic antidepressants, including Zoloft, Prozac, Paxil, and Celexa (if one doesn't work well, another still might); lithium carbonate; beta blockers (such as atenolol); clonidine; atypical antipsychotics (such as low-dose risperidone); and anticonvulsant mood-stabilizers, such as divalproex, carbamazepine, and perhaps gabapentin.

Each of these has risks and benefits that would need to be discussed carefully with your doctor. You might also discuss the possibility of joining an anger management group, or looking into one of the many on-line help sites that can point you toward tapes, books, and other aids. For example, you might want to try www.angermgmt.com. The book Angry All the Time, by Ron Potter-Efron might also be of interest. I also highly recommend A Guide to Rational Living, by Albert Ellis and Robert Harper. The bottom line: medication is only part of the overall treatment for excessive anger, in most cases.

January, 2001

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